沙库巴曲缬沙坦钠与缬沙坦联合β受体阻滞剂在维持性血液透析合并心力衰竭患者中的应用效果比较  

Comparison of the efficacy of sacubitril valsartan sodium and valsartan in combination withβ-blockers in maintenance hemodialysis patients with concomitant heart failure

作　　者：卞小燕 张燕林 BIAN Xiaoyan;ZHANG Yanlin(Department of Nephrology,Xiamen Humanity Hospital,Fujian Province,Xiamen 361000,China)

机构地区：[1]厦门弘爱医院肾脏内科,福建省厦门市361000

出　　处：《临床合理用药杂志》2024年第13期1-4,共4页Chinese Journal of Clinical Rational Drug Use

基　　金：2020年厦门市医疗卫生指导项目(3502Z20209064)。

摘　　要：目的比较沙库巴曲缬沙坦钠与缬沙坦联合β受体阻滞剂在维持性血液透析合并心力衰竭患者中的应用效果。方法选取2020年8月—2022年8月厦门弘爱医院收治的维持性血液透析合并心力衰竭患者60例,采用随机数字表法分为观察组和对照组,各30例。在常规β受体阻滞剂治疗基础上,对照组予缬沙坦胶囊治疗,观察组则予沙库巴曲缬沙坦钠片治疗,2组均治疗40周。比较2组治疗前后透析指标(干体质量、体质量增长、超滤量、收缩压、舒张压)、炎性因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]、超声心电图指标[左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、心输出量、室间隔舒张末期厚度(IVSTD)、左室后壁舒张末期厚度(LVPWTD)]变化及不良反应。结果治疗40周后,2组干体质量、体质量增长、超滤量均较治疗前无明显变化(P>0.05),收缩压、舒张压及hs-CRP、TNF-α、IL-6水平均较治疗前降低,且观察组低于对照组(P<0.05或P<0.01);观察组LVEF、心输出量均较治疗前增加,LVESD、LVEDD、IVSTD、LVPWTD较治疗前减小,且观察组各项指标治疗后优于对照组(P<0.05或P<0.01)。对照组心输出量治疗后增加(P<0.01),其余各项指标治疗前后差异无统计学意义(P>0.05)。观察组与对照组不良反应总发生率(23.33%vs.33.33%)比较差异无统计学意义(χ^(2)=0.739,P=0.390)。结论相较于缬沙坦,沙库巴曲缬沙坦钠联合β受体阻滞剂在维持性血液透析合并心力衰竭患者中的应用效果更佳,可明显改善患者血压,减轻炎性反应,对心肌重构具有积极改善作用。Objective To compare the efficacy of sacubitril valsartan sodium and valsartan in combination withβ-blockers for the treatment of maintenance hemodialysis patients with concurrent heart failure.Methods Sixty cases of maintenance hemodialysis patients with concurrent heart failure admitted to Xiamen Humanity Hospital from August 2020 to August 2022 were selected.They were randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.On the basis of conventionalβ-blockers therapy,the control group received treatment with valsartan capsules,while the observation group received treatment with sacubitril valsartan sodium tablets.Both groups were treated for 40 weeks.Changes in dialysis indicators(net weight,body weight gain,ultrafiltration volume,SBP,DBP),inflammatory factors(hs-CRP,TNF-α,IL-6),and echocardiographic parameters(LVEF,LVESD,LVEDD,cardiac output,IVSTD,LVPWTD)before and after treatment,as well as adverse reactions,were compared between the two groups.Results After 40 weeks of treatment,there were no significant changes in net weight,body weight gain,or ultrafiltration volume in either group compared to before treatment(P>0.05).SBP,DBP,hs-CRP,TNF-α,and IL-6 levels decreased compared to before treatment,with levels in the observation group were lowed than those in the control group(P<0.05 or P<0.01).LVEF and cardiac output increased compared to before treatment in the observation group,while LVESD,LVEDD,IVSTD,and LVPWTD decreased.Furthermore,the observation group showed better outcomes in all parameters compared to the control group after treatment(P<0.05 or P<0.01).Cardiac output increased in the control group after treatment(P<0.01),while there were no statistically significant differences in other parameters before and after treatment(P>0.05).There was no statistically significant difference in the total incidence of adverse reactions between the observation group and the control group(23.33%vs.33.33%,χ^(2)=0.739,P=0.390).Conclusion Comp

关 键 词：终末期肾病 维持性血液透析 心力衰竭 沙库巴曲缬沙坦钠 缬沙坦 Β受体阻滞剂 

分 类 号：R692.5[医药卫生—泌尿科学] R541.6[医药卫生—外科学]